A 27-Year-Old Man Comes to the Office Due to Cough

A 27-year-old man comes to the office due to cough, chest discomfort, and dyspnea on exertion.  Symptoms began approximately a month ago and were initially mild but have gradually worsened.  He has also lost 4.5 kg (10 lb) over the past 2 months.  The patient has no chronic medical conditions.  He smokes a pack of cigarettes a day and drinks an average of 4 beers each weekend.  The patient does not use illegal drugs and has not had multiple sexual partners.  Physical examination is unremarkable.  Chest imaging reveals a large, anterior mediastinal mass.  Subsequent blood work shows elevated levels of β-hCG and alpha fetoprotein.  Which of the following is the most likely diagnosis?

A) Benign teratoma
B) Bronchogenic cyst
C) Hodgkin lymphoma
D) Nonseminomatous germ cell tumor
E) Seminoma
F) Thymoma

Correct Answer:

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